Domperidone and ARVD

[Helen Marshall IBCLC]

I have a client who is considering starting Domperidone due to low milk supply however she has been reading all the information about the potential cardiac risks. She has a first cousin with ARVD and is concerned this puts her into a higher risk catergory. Her GP is also hesitant due to lack of information. Would you suggest an ECG before starting or is this not at all a risk factor?

Thanks

[admin]

Helen:

I do not know if there is any heritable risk of the arrhythmic syndrome in your patient (ARVD), I doubt there is however. That said, its not much trouble to get an ECG done to be certain she does not have a prolonged QT interval, which is what domperidone rarely precipitates.

My advice is to get a prolactin level first. If it is elevated ( > 70 ng/mL) then domperidone is a waste of time and won't work. If it is low (10-30 ng/mL), then domperidone may work. Keep the dose at 10-20 mg TID, and no more. This is all you need to stimulate prolactin levels into the milk producing range.

Good luck.

Tom Hale Ph.D.